Des solutions au bruit en CPE / La Loi sur le tabac

MARIE-ANDRÉE BEAUPRÉ
ASSTSAS
DES SOLUTIONS
AU BRUIT EN CPE
Imaginez-vous le bruit généré par
toute la marmaille d’un centre de la
petite enfance (CPE) ! Les effets du
bruit sur la santé des éducatrices et
des enfants sont nombreux.
L’ASSTSAS, en collaboration avec la
Commission de la santé et de la sécurité du travail, s’est penchée sur le problème. L’Institut de recherche RobertSauvé en santé et en sécurité du travail
a réalisé une recherche qui a mené à
l’implantation de solutions acoustiques
dans les locaux de neuf CPE. Les résultats de ces travaux, les effets du bruit,
la réglementation et les moyens pour
remédier aux situations bruyantes sont
présentés dans ce numéro spécial.
« Réduire le bruit dans les services
de garde : solutions acoustiques »,
Sans pépins, vol. 8, no 2, juin 2006,
32 p. (www.asstsas.qc.ca).
LA LOI SUR LE TABAC
Qu’en est-il de cette loi pour les personnes hébergées et le personnel d’un
établissement de santé et de services
sociaux qui continuent à fumer ?
L’Association québécoise d’établissements de santé et de services sociaux
(AQESSS) vient de publier un guide.
Il résume bien ce qu’il ne faut pas
faire : « ... il sera désormais interdit
aux établissements de santé et de services sociaux et aux ressources intermédiaires (excepté une demeure privée) d’aménager des aires intérieures
où il est permis de fumer. Également,
il sera interdit de fumer à l’extérieur
de ces deux catégories d’endroits, dans
un rayon de neuf mètres de toute porte
communiquant avec cet endroit. »
Le guide précise aussi ce qu’il est encore possible de faire : « ... la loi prévoit quelques exceptions. Ainsi, les
établissements de santé et de services
sociaux hébergeant des personnes
pourront aménager, dans chacune de
leurs installations où sont hébergées
des personnes, un fumoir fermé et
uniquement réservé à ces dernières, en
autant que ce fumoir soit conforme à
certaines normes techniques. De plus,
les établissements exploitant ces
mêmes centres pourront désigner des
chambres où les personnes hébergées
peuvent fumer, mais à certaines conditions. »
AQESSS. Guide actualisé de la Loi
sur le tabac dans les établissements
de santé et de services sociaux, 2006,
57 p. Disponible au coût de 15,90 $
pour les membres et 53 $ pour les nonmembres (www.aqesss.qc.ca).
PREMIER CONGRÈS
FRANCOPHONE SUR LES TMS
Les troubles musculosquelettiques
(TMS) n’ont qu’à bien se tenir, car une
panoplie impressionnante de préventionnistes, d’ergonomes, de chercheurs,
de médecins, d’infirmières et d’infirmiers du travail les observent sous tous
les angles.
Ce premier événement a mis l’accent sur les acquis scientifiques et les
perspectives de la recherche. Des présentations ont porté sur l’organisation
du travail, les facteurs psychosociaux,
la surveillance des TMS en entreprise,
les outils de prévention, etc. Diane
Berthelette, de l’IRSST, a exposé son
évaluation d’un programme de prévention des maux de dos comme la
formation PDSB.
INSTITUT NATIONAL DE RECHERCHE ET DE SÉCURITÉ. Actes du 1er
congrès francophone sur les TMS.
Écrire « congrès TMS » dans la boîte
de recherche de la page d’accueil
(www.inrs.fr).
PARCE QUE VOTRE SANTÉ
NOUS TIENT À CŒUR !
Signalons à nouveau l’importance
de la marche pour garder la santé, la
forme et la vitalité. Les médecins la
recommandent à leurs clients et les
motivent à utiliser un podomètre. Ce
petit appareil électronique, que l’on
attache à la ceinture, indique le nombre de pas effectués. Pourquoi attendre
le médecin pour s’en prescrire l’utilisation. Faisons-le nous-mêmes !
GAUDET-SAVARD, T., P. POIRIER.
« Le podomètre : un nouvel outil pour
simplifier votre prescription d’exercice », MedActuel FMC, février 2004.
Disponible sur le site de l’ASSTSAS
(www.asstsas.qc.ca/dossier/inno06/
images/Grand_littoral_texte.pdf).
COMMUNICATION
À L’AIDE D’AFFICHES
Êtes-vous à la recherche d’idées
afin de promouvoir la prévention
sous toutes ses formes ? Parfois une
simple affiche avec le bon message
peut valoriser, motiver et mobiliser le
personnel. Il y en a pour tous les
besoins : bioalimentaire, communication, entretien préventif, esprit
d’équipe, humour, motivation, etc.
Prosper international (www.prosperinternational.com/fr).
DOULOUREUX ÉCRASEMENTS
DES PILULES !
Manrex, distributeur de l’écrasepilules Powdercrush, a fait la traduction d’un article publié dans Objectif
prévention (vol. 28, no 3). L’article
en anglais, Painful Pill Crushing,
est maintenant disponible sur notre
site Internet (www.asstsas.qc.ca).
L’écrase-pilules
Powdercrush de
Manrex : marteler
le sachet en pressant
sur le bouton.
OBJECTIF PRÉVENTION – VOL. 29, NO 4, 2006 – 31
D O S S I E R
p h a rm a c ie
Painful Pill Crushing
Do workers risk injury while crushing pills?
Of
course! Indeed, more and more often are musculoskeletal problems arising from this activity. Different factors can explain this
situation.
Fortunately, equipment is being upgraded. Two new pill crushers permit reduction of stress. Tests conducted in four institutions
show how this equipment is making work easier. Read on to satisfy your curiosity.
Institutional Testing
Four institutions wishing to improve working conditions associated with pill crushers made an appeal to ASSTSAS. We proposed
they test two new pieces of equipment. The tests were conducted at
the following institutions:
A
B
2A, B. Two common models of pill crushers.
1. Typical posture of an employee operating a pill
crusher: the right arm higher than the level of the
shoulders (in abduction), application of force on
the handle with an uncomfortable grip.
> Health and Social Services Centre
(HSSC) Québec-Sud, General Hospital of
Québec ;
> HSSC Haut-Richelieu/Rouville, located
in CLSC of Richelieu/Rouville Centre;
> HSSC Richelieu-Yamaska, Hôtel-Dieu de
Saint-Hyacinthe ;
> Grace Dart Long-Term Care Centre, in
Montréal.
We emphasize that the testing institutions have not made comparisons between
the two pill crushers presented in this article. They have compared their usual equipment to one or the other of the new proposed models. In total, 60 people tried the
electric model Powdercrush from Manrex
and 39 people tried the Ultimate Pill Crusher, a manual model from AB Innovations.
New Tools on the Market !
The easy-to-use Powdercrush (photos 3
to 6), sets itself apart because of its electronic function. Pills have to be placed in a
sufficiently resistant polyethylene pouch. A
maximum of three or four pills can be
crushed at the same time, subject to their
characteristics (size and resistance). Following this, the top of the pouch is rolled up
and the pouch is inserted into the slot of
the apparatus. By pressing the start button,
the pouch is struck as many times as is necessary. The pouch is then emptied of its
contents and discarded. A new pouch is
– OBJECTIF PRÉVENTION – VOL. 28, NO 3, 2005
The Risk Factors
Crushing pills can become difficult depending on the equipAngélique Métra
ment
used, the height of the work surface and also the toughness
asstsas
and the resistance of the coating of certain tablets. One study, undertaken by OHSAH (Occupational Health and Safety Agency for
Healthcare, in British Columbia), shows that the customary force
required to crush pills for migraines can attain 36 kg (360 newtons). The 500 mg calcium pills are among the most difficult to
crush.
The design of the pill crusher and the type of work surface can
lead staff to adopt stressful postures for the shoulders and wrists
(photo 1). For example, abduction of the prominent arm, higher
than the level of the shoulders, and the application of force can
Jocelyn Villeneuve
cause pain. Moreover, several pill crushers do not offer a strong
asstsas
grip (photos 2A and B). The repetitive aspect of the task, up to
several hundreds of times every shift, increases even more the
risk of musculoskeletal troubles appearing, such as bursitis or tendonitis.
Another problem that has
been
reported concerns the
The repetitive aspect of the task,
noise transmitted by the pill
up to several hundreds of times
crushers. Indeed, the noise can
every shift, increases even more
present a nuisance as much as
for the clients, particularly in the
the risk of musculoskeletal trouevening, as for the staff. Bebles appearing.
sides, certain medications leave
a fine powder in suspension in the air, which must be avoided if
at all possible.
D O S S I E R
p h a rm a c ie
used for subsequent activations.
The Ultimate Pill Crusher (photos 7 to 11), a manual easy-to-use model, requires
some prior familiarization. First, insert the medications between two paper or plastic pill containers. Then, set the stacked containers on the anvil and pull the lever down gently until the
hammer and the anvil come together (starting point position).
With both hands gripping the handle, exert light pressure. The impact is absorbed by
the rotating movement of the anvil under the hammer. The operation needs to be repeated
according to how much crushing
is desired, and the toughness of
The Powdercrush grinds pills
the pills. There is no need to
completely raise the lever bemore efficiently and more unitween crushing repititions, it is
formly with little effort.
only necessary to reset the handle
of the lever to its starting point and to gently turn the containers.
Evaluating the Comments
Powdercrush
Everyone agrees! The Powdercrush grinds pills more efficiently and more uniformly,
with little effort. The emphasis is on its ease of utilization and its stability. It allows the
crushing of tablets into fine powder, for example, for use in cases of tube feeding.
Certain less appreciated aspects concern noise and dimensions (height: 9.5 cm - 3.8
inches; width: 8.5 cm - 3.4 inches; length: 28 cm - 11 inches; weight: 2.7 kg - 6 lbs). One
institution felt that the necessity of recharging the batteries was not acceptable, worrying
that the staff would forget to do it. The performance of the Powdercrush is actually greatly
reduced when the batteries are low. Manrex recommends recharging them after each session.
In other respects, several people mention the possibility of inhaling powder or getting it
on their fingers. Manrex recommends using a specifically resistant type of pouch. The supplier also specifies folding the pouch opening twice and leaving at least 2.5 cm (1 inch)
free up to the medications. Respecting these recommendations would permit minimal
emission into the air.
Ultimate Pill Crusher
Among the positive aspects pointed out, is that of stability of the device (non-skid ma-
– OBJECTIF PRÉVENTION – VOL. 28, NO 3, 2005
3. Powdercrush, Manrex, electric model.
4. Insert the pill into
the pouch.
5. Double-fold the
opening.
6. Strike the pouch by pressing the button.
Unsolicited Comments
from Testers !
Powdercrush
"There is less strain. It is faster and more efficient!" "No effort required, no more pain, in the
shoulder nor the wrist." "Easier to use, does not
require any arm or shoulder effort. Also this apparatus gives us a tablet that has been well
crushed into fine powder. The only fault: it is
noisy. Sometimes Senokot remains difficult to
crush when it is placed together with other, larger pills. It takes several attempts. When there are
several pill forms, more than three or four, the
pouch can get pierced!" "Really crushes into a
powder. Excellent for cases of tube feeding."
"Pills are well crushed. Requires no physical effort. Little loss of powder within the pouch."
"Faster and much less effort. No wasted medications."
Ultimate Pill Crusher
"Lighter, less noise." "No shock during use, prevents accidents due to repetitive movements."
"Efficient, easy manipulation, and rather good
stability." "Less effort, safer." "Less noise, requires less effort, more comfortable." "Does not
grind into a fine powder."
Additional comments about certain medications
that remain more difficult to crush: Calcium 500
mg,Senokot, Norvasc, Byprexa, Liorisal.
terial under the base). If necessary, it can
be attached to the medication cart or to a
counter. With the Ultimate Pill Crusher,
workers feel that their upper limbs stay in a
natural and comfortable position, eliminating the elevation of the arms. The solid
comfortable handle allows a two-handed
grip. The effort is less than that required
with common pill crushers. The impact absorption movement (arising from under the
anvil) eliminates repetitive striking and reduces the noise level.
Nevertheless, several tries are necessary
in order to crush the pills: 3 to 12 times depending on the toughness and the number
of tablets. It is advisable therefore to avoid
crushing too many pills at the same time in
order to obtain the best result and to ensure that the powder does not get out of
the container.
It is possible to add a flat disk on the anvil (to be fastened with metal glue.) The
supplier has fabricated this piece following
D O S S I E R
With the Ultimate Pill Crusher,
workers feel that their upper
limbs stay in a natural and comfortable position.
p h a rm a c ie
the recommendations of ASSTSAS. The institutional tests demonstrated that the paper pill containers were indeed tearing by the
friction of the granules on the jagged base of the anvil. This piece
must be ordered separately on purchase of the pill crusher.
And so, the arrival of easy crushing?
Crushing more safely, myth or reality? In any case, even if perfection has not yet been attained, there is no doubt that the progress made is significant and probably marks a notable turning
point in the world of pill crushers. It's up to you to see them and
try them out! In other respects, research is ongoing and we are
keeping our eyes open for you!
•
Disk to stick on
the anvil.
R E feren c es
ENGST, C., R. HALL, A. YASSI, D. ROBINSON, B. KEANE. Development Process for an
Ergonomic Pill Crusher, Association of Canadian Ergonomists, Conference 2002,
Banff, AB.
ASSTSAS. « Pas facile d’écraser des pilules ! », Objectif prévention, vol. 25, no 1, 2002, p. 32.
7. Ultimate Pill Crusher, AB Innovations, manual model.
9. Place the second container in
the first.
Powdercrush, Manrex
(Electric)
10. Place the stacked containers
on the anvil.
Ultimate Pill Crusher, AB Innovations
(Manual)
Strong Points
>Effortless
>No postural constraints
>Crushes tablets into fine powder
>Simple to use
>Stable
>Less effort
>Less postural constraints to upper limbs
and shoulders
>Better crushing of tablets without
hammering
>Stable
Weak Points
>Noisier
>Heavier
>Larger
>Requires battery recharging
>Requires more than one attempt to
crush pills (3 or more)
>Directions to follow
>Manual guidance of containers
More Suitable for
>Pills in pouch
>Tube feeding of patients
>Grinding of pills over a continuous
period (e.g., in pharmacy)
>Pills not in pouch
>Usage of paper or plastic pill containers
>Coarser grinding of tablets
11. With two hands, lower the lever and press the
pills.
Distributors
Manrex
300 Cree Crescent,
Winnipeg (Manitoba) R3J 3W9
Tel.: 1 800 665-7652
www.manrex.com
Québec Representative: Doris Boudreault
Tel.: 418 687-2506
AB Innovations Inc.
33 050, Whidden Avenue
Mission (British Colombia) V2V 2T2
Tel.: 604 820-4855
[email protected]
Contact: Dennis Kruger
(pill crusher: 366DDD ;
Add-on piece for base: AMJV)
– OBJECTIF PRÉVENTION – VOL. 28, NO 3, 2005
8. Insert the pill in the first container.